Earlier this week I fielded a question from Michele from Florida. She wondered if she should get crowns or veneers for her severely tetracycline-stained teeth. I asked her some questions about the fees and the dentist she was talking about. Here is her reply, and my response to that reply:

Dr. Hall
Thanks for your input. The cosmetic dentist is Dr. A (name withheld to help preserve Michele’s identity). He wants to charge me $42,000 for a full mouth of veneers (two teeth require crowns due to damage). The other dentist wants $26,000 for crowns. My budget cannot go over $30,000. Also, I forgot to mention that I grind my teeth at night and wear an appliance. I’ve read that veneers don’t stand up to grinding as well as crowns.

My response:

I know the cosmetic dentist you went to, and he is really good. He would give you a stunning smile. I’m not surprised that his fees are high—he is worth it.
About your grinding (also called bruxism). If you wear your nightguard, you should have no problem with your veneers. If you grind your teeth, you are actually at higher risk with crowns because then you don’t just chip off the edge—you break off the entire tooth. I had several patients who had to deal with that and you end up with implants later in life. Once you break off a front tooth at the gumline, if you’re a grinder, there isn’t a whole lot you can do with it. You see, with a crown you grind off a full millimeter of the tooth, all the way around. So if you have an upper lateral incisor that is 5 or 6 millimeters in diameter (let’s say 5.5 mm) at the gumline, then you grind down 1 mm all the way around, you now have 3.5 mm diameter. So you used to have a cross-sectional area of 95 square mm – now you have 38 square mm. So you now have 40 % of the strength left, when you’re talking about resistance to breaking off at the gumline. People who grind break these teeth off when they’ve been prepared for crowns. The lower teeth are even worse. You actually cut the strength of lower incisors down to about 1/4th of their original strength.
Here are a couple of options I would suggest:
1. Do just the upper with Dr. A and do Kör Whitening on the lower. That way you get a stunning smile and cut the cost about in half. Kör, if you use it for long enough, will have a significant effect on the tetracycline stains and lighten them enough to be acceptable as lower teeth. Then at some later point, if you feel you need to improve the result even further, you could do the lower. I had a couple of cases of tetracycline stain that I treated where we did just the uppers and didn’t do anything to the lower. With most people, the lowers don’t show as much, especially if you are younger. And even when they do show, they are kind of in the shadows.
or
2. Check out Dr. B. He is in your city. I know him also, and he also does beautiful work and his fees might be within your budget. His work isn’t at the level of Dr. A, but it’s good. Call and find out what he charges per tooth for porcelain veneers. If that doesn’t work, you could find someone else that you could drive to see. I’m confident you could find someone who could do beautiful porcelain veneers and stay within your budget. Even if you needed to fly somewhere, if the fees were $15,000 less, it would be worth it.
The interesting thing about the costs of cosmetic dentistry is that really the fees are pretty comparable for a good general dentist and a good cosmetic dentist (with the exception of exceptional artists like Dr. A).

Dr. Hall

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